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激素三种不同给药方式治疗突发性耳聋的疗效比较
Efficacy of Three Corticosteroid Treatment Modalities for The Treatment of Sudden Sensorineural Hearing Loss
【作者】 王强；
【导师】 段茂利；
【作者基本信息】 安徽医科大学 ， 耳鼻咽喉科学， 2015， 硕士
【摘要】 目的探讨糖皮质激素三种给药途径治疗突发性耳聋疗效的比较.方法选取2013年8月至2014年6月在安徽医科大学第一附属医院耳鼻咽喉-头颈外科住院治疗突发性耳聋的患者90例,按照住院顺序随机分为A、B、C三组,每组在应用扩张血管、营养神经治疗药物的基础上,A组加用口服甲泼尼龙琥珀酸钠片,B组加用静脉滴注甲泼尼龙琥珀酸钠注射液,C组加用鼓室注射甲泼尼龙琥珀酸钠注射液,在治疗前及治疗后一个月分别行纯音测听检查。结果A组患者痊愈6例,显效4例,有效6例,总有效率为53.3%(16/30)。B组患者痊愈7例,显效2例,有效7例,总有效率53.3%(16/30)。C组患者痊愈8例,显效7例,有效6例,总有效率70%(21/30)。A、B、C组患者听力的平均提高值分别为16.1±15.3 d B,14.3±12.7 d B,21.6±20.4 d B。C组总有效率及听力平均提高值与A、B组比较有统计学意义(p<0.05)。A组和B组的总有效率及听力平均提高值无统计学意义(p>0.05)。在重度突发性耳聋的患者中,鼓室注射激素使患者的平均听力提高为27.2±23.5 d B大于A组的14.4±13.9 d B及B组的15.1±12.6 d B。在治疗过程中无中耳炎、鼓膜穿孔、听力进一步下降等并发症发生。结论鼓室注射治疗突发性耳聋的疗效优于全身用药,对于初发的突发性耳聋患者、全身应用激素有禁忌症以及重度突发性耳聋的患者推荐使用鼓室注射治疗方法。
【Abstract】 Objective The purpose of present study was to evaluate the efficacy of systemic steroid therapy compared with intratympanic steroid treatment in the patients of Sudden Sensorineural Hearing Loss(SSNHL).Methods Participants were chosen who had unilateral SSNHL referred to the department of otolaryngology of the First Affiliated Hospital of Anhui Medical University between October 2013 and June 2014, 90 patients were randomized divided into three groups were equally(n=30 per group). Group A patients were given oral methyprednisolone tablets, group B patients received intravenous methyprednisolone injection, and group C patients received intratympanic methyprednisolone(MEPD) injection. Pure tone average(PTA) was obtained at pre- and post-treatment as well as one month after.Results In group A, 6 patients experienced complete recovery and 4 a marked recovery, 6 a slight recovery. In Group B, 7 patients reached complete recovery, 2 a marked recovery, 7 a slight recovery. In contrast, 8 patients had a complete recovery, 7 a marked recovery, 6 a slight recovery in Group C. The general effective rate in Group A, Group B, and Group C was 53.3%(16/30), 53.3%, and 70%(21/30), respectively. The mean improvement hearing level were 16.1±15.3 d B, 14.3±12.7 d B, and 21.6±20.4 d B in group A, group B, and group C, respectively. Both the general effective rate and hearing improvement gain were significantly higher in group C than in group A and in group B. While, there was no significant difference between group A and group B with regard to the general effective rate and hearing improvement gain. During the severe hearing loss patients, the hearing improvement was 27.2±23.5 d B in C group higher than 14.4±13.9 d B in B group and 15.1±12.6 d B in C group. No media otitis and residual tympanic membrane perforations were observed in any of the individuals at their last visit and we did not find any case who’s hearing loss worsened during the treatment.Conclusions Local injection by intratympanic was better than systemic administration from present study in the treatment of SSNHL and we recommend to use ITIS for the initial SSNHL especially for patients who has limitation to use steroid systemically and severe hearing loss.